Provider Demographics
NPI:1407215569
Name:KEENAN, RENEE E (CRNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:KEENAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:5TH FLOOR TOLL BLDG
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-4100
Mailing Address - Fax:215-481-4199
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:5TH FLOOR, TOLL BLDG
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-4100
Practice Address - Fax:215-481-4199
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015374363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA482521Medicare PIN